| Glisan Dental Corporation | |
|
7990 Ne Glisan St Portland OR 97213-7040 | |
| (503) 208-2220 | |
| Not Available |
| Full Name | Glisan Dental Corporation |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 7990 Ne Glisan St, Portland, Oregon |
| Authorized Official Name and Position | Tan Ba Pham (DENTIST) |
| Authorized Official Contact | 5032082220 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Glisan Dental Corporation 7990 Ne Glisan St Portland OR 97213-7040 Ph: (503) 208-2220 | Glisan Dental Corporation 7990 Ne Glisan St Portland OR 97213-7040 Ph: (503) 208-2220 |
| NPI Number | 1316178734 |
|---|---|
| Provider Enumeration Date | 08/03/2009 |
| Last Update Date | 08/03/2009 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1316178734 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |
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